Madelung Deformity | Diagnosis & Treatments

At Boston Children's Hospital, our Hand and Orthopedic Upper Extremity Program provides comprehensive care for patients with Madelung deformity — including evaluation, diagnosis, consultation, surgerym and follow-up care.

Many kids and teens with Madelung have no pain or limitations in their daily activities. In these case, no surgery is necessary. Your child's doctor will probably recommend that you bring her in periodically to monitor the progression, if any, of the condition.

If your child has pain, trouble using the wrist, or progressive deformity, her doctor may recommend surgical treatment.

Testing for Madelung deformity

Madelung is usually diagnosed by physical examination when the deformity becomes apparent. This is usually when a child is between 8 and 14 years old, although the condition sometimes shows up earlier.  

Your child’s doctor will take a thorough medical history and perform a careful physical examination. Typically, x-rays confirm the diagnosis.

  • To confirm a diagnosis of Madelung deformity, the doctor orders x-rays to look closely at the underlying structure of your child’s wrist bones, to check for related conditions; and to determine the best course of treatment.
  • To evaluate whether genetic syndromes are involved, Boston Children’s may also perform genetic testing.
  • There are some conditions that can cause deformities that mimic the Madelung deformity, including sickle cell disease, post-traumatic growth plate disturbance of the radius, bone dysplasia and others. The doctor will rule out other possible conditions using physical exam, X-rays, and occasionally, MRI (magnetic resonance imaging) or CT scans (computed tomography).

How Boston Children's Hospital treats Madelung deformity

If a child is pain-free with mild deformity, she will probably be treated with simple observation, rather than surgery. But if the child or teen is experiencing pain, limited range of motion or other significant problems, surgery is likely to be indicated.

Surgical approaches can include corrective soft tissue and bony procedures. In general, the goals of surgery are to reposition and stabilize your child's wrist so she can move it without pain and to prevent the deformity from worsening.

Surgical treatment options

The type of surgery the doctor recommends depends on your child's age, degree of deformity, functional limitations and general health. Surgical approaches can include corrective soft tissue and bony procedures, such as:

  • Physiolysis: releasing or correcting the growth plate abnormality of the radius
  • Corrective osteotomy: cutting and realigning the end of the radius
  • Ulnar-shortening osteotomy: shortening the ulna bone to level the wrist
  • Darrach procedure: removing the part of the ulna that is protruding

We also may recommend a procedure called a wrist arthroscopy to evaluate and treat any cartilage injury within the wrist joint. 

Complications of surgery

Complications are rare, but can occur, including:

  • nerve damage
  • incomplete correction (alignment) between the right and left sides
  • recurrence of the condition

After surgery

Most of the time after surgery the child’s bones heals, the deformity corrected, the pain improved, and the appearance of the wrists improves. But recurrence of the condition may occur, especially in younger children. Boston Children’s doctors use several treatment strategies to help minimize the risk of recurrence.

Coping and support 

At Boston Children's Hospital, we understand that a hospital visit can be difficult, and sometimes overwhelming. So, we offer many amenities to make your child's, and your family's, hospital experience as pleasant as possible. Visit the Hale Family Center for Families or all you need to know about:

In particular, we understand that you may have a lot of questions when your child is diagnosed with Madelung deformity. Boston Children's can connect you with extensive resources to help you and your family through this stressful time, including: 

  • Patient education: From doctor's appointments to physical therapy and recovery, our nurses and physical therapists will be on hand to walk you through your child's treatment and help answer any questions you may have — Why will my child need surgery? Are there non-surgical options? How long will her recovery take? How should we manage home exercises and physical therapy? We'll help you coordinate and continue the care and support your child received while at Boston Children's.
  • Parent-to-parent: Want to talk with someone whose child has been treated for Madelung? We can often put you in touch with other families who've been through the same process that you and your child are facing, and who will share their experiences.
  • Faith-based support: If you're in need of spiritual support, we'll connect you with the Boston Children's chaplaincy. Our program includes nearly a dozen clergy — representing Protestant, Jewish, Muslim, Roman Catholic, and other faith traditions — who will listen to you, pray with you and help you observe your own faith practices during your hospital experience.
  • Emotional support: Our social workers and mental health clinicians have helped many families in your situation. We can offer counseling and assistance with issues such as coping with your child's diagnosis, stresses relating to coping with illness and dealing with financial difficulties.